EMERALD COAST EAR, NOSE, THROAT & ALLERGIES, P.A.
Managed Care Organizations at Mar Walt Dr, Fort Walton Beach, FL

License number
Florida ME93776
Category
Managed Care Organizations
Type
Health Maintenance Organization
Owner
Name: DR. JOSEPH DANIEL SIEFKER MD
Title: DOCTOR
Phone: (850) 796-1368
Address
Address
1032 Mar Walt Dr SUITE 100, Fort Walton Beach, FL 32547
National Provider ID: 1265477574
LicenseFiles verified this license of Nov 7, 2017 at the National Plan and Provider Enumeration System.

Organization information

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EMERALD COAST EAR, NOSE, THROAT & ALLERGIES, PA

1032 Mar Walt Dr SUITE 100, Fort Walton Beach, FL 32547

Status:
Inactive
Doing business as:
Emerald Coast Ear, Nose, Throat & Allergies, P.A
Inactive reason:
REINSTATEMENT
Registration:
Mar 7, 2005
Inactive since:
Jun 28, 2012
State ID:
P05000039234
Business type:
Florida Profit Corporation
Director:
Joseph D Siefker (Director), 1032 Mar Walt Dr SUITE 100, Fort Walton Beach, FL 32547 (Physical)
Agent:
C Mcinnis,909 Mar Walt Dr SUITE 1014, Fort Walton Beach, FL 32547 (Physical)
EIN:
202535830

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